Cases reported "Apraxias"

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11/82. Dissociated active and passive tactile shape recognition: a case study of pure tactile apraxia.

    Disorders of tactile object recognition (TOR) may result from primary motor or sensory deficits or higher cognitive impairment of tactile shape representations or semantic memory. Studies with healthy participants suggest the existence of exploratory motor procedures directly linked to the extraction of specific properties of objects. A pure deficit of these procedures without concomitant gnostic disorders has never been described in a brain-damaged patient. Here, we present a patient with a right hemispheric infarction who, in spite of intact sensorimotor functions, had impaired TOR with the left hand. Recognition of 2D shapes and objects was severely deficient under the condition of spontaneous exploration. Tactile exploration of shapes was disorganized and exploratory procedures, such as the contour-following strategy, which is necessary to identify the precise shape of an object, were severely disturbed. However, recognition of 2D shapes under manually or verbally guided exploration and the recognition of shapes traced on the skin were intact, indicating a dissociation in shape recognition between active and passive touch. Functional MRI during sensory stimulation of the left hand showed preserved activation of the spared primary sensory cortex in the right hemisphere. We interpret the deficit of our patient as a pure tactile apraxia without tactile agnosia, i.e. a specific inability to use tactile feedback to generate the exploratory procedures necessary for tactile shape recognition.
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12/82. rehabilitation of Balint's syndrome: a single case report.

    Very little research has been done in the area of rehabilitation of the visual perceptual deficits observed after Balint's syndrome. This syndrome is characterized by difficulties with visual scanning, dysmetria secondary to visual perceptual deficits, and an inability to perceive more than 1 object at a time. This article describes the effects of a neuropsychological treatment protocol on a 23-year-old patient who suffered a fat embolism involving the territory of the posterior cerebral arteries. A neuropsychological evaluation carried out 12 months after the brain embolism disclosed Balint's syndrome, alexia without agraphia, visual agnosia, prosopagnosia, and memory impairments. The rehabilitation protocol included both visuoperceptual retraining and a functional program designed to provide rehabilitation in contexts that were meaningful to the patient. After 1 year of treatment, a second neuropsychological evaluation was carried out. Significant improvement was demonstrated in terms of both objective testing and the return of an integrated and productive lifestyle.
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keywords = visual
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13/82. Mechanisms of dressing apraxia: a case study.

    OBJECTIVE: To investigate the neural mechanisms that differentiate dressing apraxia from other forms of apraxia such as ideomotor apraxia. Hypotheses examined included (1) that dressing is more sensitive to alternations in body schema, (2) that dressing is a demanding bimanual task, and (3) that clothing represents a particularly complex spatial problem. BACKGROUND: A focal degenerative condition can specifically target a function such as dressing, allowing a unique approach to its study. METHOD: A case study of the cognitive impairments of a 75-year-old man who presented with progressive dressing difficulties in the absence of neglect or motor disturbances. RESULTS: Neuropsychologic testing indicated possible executive function deficits as well as visuospatial and visuocontructional deficits, but intact praxic skills, verbal abilities, and visual recognition skills. In addition, testing revealed no evidence of Balint's or impairments in body schema. CONCLUSION: overall, the test results suggested that visuospatial dysfunction is the underlying deficit in dressing apraxia. The present case study confirmed the independence of praxic functioning from spatial ability and conversely, the dependence of dressing on spatial ability.
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keywords = visual
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14/82. Balint's syndrome in a 10-year-old male.

    A 10-year-old male was referred with difficulties at school. He had particular difficulty with reading long words, following the sequence of text down a page, writing words in the correct order, writing words in line, and copying from the blackboard. He had a history of infective endocarditis complicated by intracerebral haemorrhage at the age of three years. Detailed history taking revealed symptoms typical of 'dorsal stream' pathology, namely a deficit of 'vision for action'. This included a spatial disorder of attention (simultanagnosia), defective hand and foot movements under visual control (optic ataxia), and acquired oculomotor apraxia which are consistent with Balint's syndrome. Strategies were suggested for coping with the symptoms and one year later a distinct improvement in adapting to the disability was found.
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keywords = visual
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15/82. The cognitive impairments due to the occipito-parietal brain injury after gunshot. A successful neurorehabiliation case study.

    OBJECTIVE: The presented case study describes the beneficial results of the neuropsychological rehabilitation of a gunshot victim, even with late initialization of the therapy--over 1 year after head trauma. DESIGN: A case study of DE, a victim with bilateral damage of the parietal-occipital regions of the brain due to a gunshot. methods: Neuropsychological rehabilitation, first preceded by an initial neuropsychological examination (standard psychological tests: WAIS-R, RAVLT, Rey's CFT, BVRT and clinical experiments tailored to DE's condition), was initiated 1 year after trauma. The rehabilitation programme consisted of computer-based tasks, paper-and-pencil exercises, and occupational therapy. The patient's progress was assessed as improvement in performance in standardized tests and computer-based tasks. RESULTS: DE was diagnosed with complex cognitive deficits syndrome, including visual associative agnosia, apraxia, visuospatial and constructive disorders and linguistic defects. After 1 year of rehabilitation the patient's functioning significantly improved as measured by psychological tests and computer-based tasks (p<0.05) as well as the evaluation of the patient's quality of life. CONCLUSIONS: The case study demonstrates beneficial effects of neurorehabilitation even initialized at the so-called 'late stage' after a brain injury.
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ranking = 0.107841432626
keywords = visual
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16/82. Selective dysfunction of tool-use: a failure to integrate somatosensation and action.

    Apraxia is thought to reflect a disruption to high-level perceptual, cognitive and motor systems that form a distributed praxis network. Some authors suggest that apraxic deficits are unique to the neurology clinic; however, mounting evidence suggests that apraxic deficits are observable in natural contexts (e.g. Foundas et al., 1995). Naturalistic gesture production involves the integration of conceptual knowledge, gesture ideation, visual and somatosensory cues, and executive processes. Impairments in this context are therefore of interest from a clinical and theoretical standpoint. We present the case of a young female stroke patient (CK) demonstrating a novel limb praxis profile. CK's conceptual, evocation and praxis executive stages were evaluated: performance was contrasted to 30 healthy controls. CK was able to pantomime and imitate transitive gestures, suggesting that her ideational, executive and visual analytic systems were intact. Moreover, CK showed a good conceptual understanding of tools, objects and actions. However, CK demonstrated poor gesture production when actually using the tool associated with the action--a chronic and bilateral deficit that persisted at a 5-year follow-up assessment. Thus, CK's deficit appears to represent a specific and chronic disruption to high-level praxis systems that incorporates tactile inputs into the unfolding gesture production sequence.
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ranking = 0.215682865252
keywords = visual
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17/82. Pathologically confirmed corticobasal degeneration presenting with visuospatial dysfunction.

    Corticobasal degeneration (CBD) typically manifests as progressive asymmetric rigidity and apraxia, although other non-motor presentations have been reported. We report two patients with pathologically diagnosed CBD who presented with prominent visuospatial dysfunction. The pathological changes were maximal in the visual association cortices, but absent in 31 cases of pathologically proven CBD with more typical antemortem features. Underlying CBD should be considered in the differential diagnosis of patients with findings reflecting posterior cerebral dysfunction.
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ranking = 0.107841432626
keywords = visual
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18/82. Selective deficit of motor imagery as tapped by a left-right decision of visually presented hands.

    This paper presents the case of MT, a patient suffering from apraxia with left-hemisphere damage who showed a selective deficit in mentally rotating images of hands whereas he was still able to mentally rotate other visual stimuli. The deficit was particularly evident when MT was asked to decide which hand (left or right) was represented in a picture. suggested that in order to carry out this task, participants would mentally rotate a representation of their own body part until it aligns with the stimulus and it does appear that MT's ability to mentally simulate movements is impaired. In contrast, he was able to mentally rotate other forms of bi- and three-dimensional stimuli. Our findings are also consistent with proposal that there are at least two ways in which objects can be mentally rotated, one that recruits processes devoted to motor preparation (e.g., hands), and another that does not.
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ranking = 0.53920716313
keywords = visual
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19/82. Slowly progressive limb-kinetic apraxia with a decrease in unilateral cerebral blood flow.

    We report two patients with slowly progressive motor disorders, whose principal manifestations were asymmetric limb-kinetic apraxia and muscle rigidity. In both patients MRI revealed no responsible lesion, whereas single photon emission computed tomography (SPECT) showed a decrease in cerebral blood flow (CBF) in the unilateral hemisphere. One patient with mainly right-sided apraxia had a decreased CBF in the left central region between the frontal and parietal cortices, and the other patient with left-sided apraxia in the right parietal cortex. In agreement with asymmetric clinical symptoms, the regional CBF decrease in the unilateral cortical areas including the frontal and parietal cortices may suggest a degenerative disease, presumably diagnosed as having cortico-basal degeneration.
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keywords = cortex
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20/82. Lesion localization in apractic agraphia.

    Apractic agraphia is an impairment in writing in which the actual orthographic production of letters and words is abnormal despite normal sensorimotor function, visual feedback, and word and letter knowledge. We report one case and review the limited clinicoanatomical literature. Analysis of available cases supports the hypothesis that apractic agraphia is one of several related clinical disorders that are due to the loss of spatially and kinesthetically modulated movements. It is produced by lesions in the superior parietal lobule, usually in the hemisphere dominant for language.
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ranking = 0.107841432626
keywords = visual
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